Aptitude: A neat test for doctors

6/20/2016

Much has been written about the pros and the cons of the National Eligibility and Entrance test (NEET). The magnitude of the test, the feasibility of this being fair and transparent, and the genuine concern that this would not be a level playing ground for students from the non-CBSE syllabus have all been teased out with a fine-toothed comb. But I would like to remind readers that to make a good doctor, there are other qualities apart from academic ability that need to be present in a candidate.

Apart from academic knowledge, the practice of medicine requires empathy and compassion that need to be tested

The practice of medicine definitely entails knowledge; however there is a dimension of medicine as a skill and medicine as a team game which requires certain skill sets and innate qualities in an individual which need to be tested at the entry point. Medicine also requires individuals to have empathy, embrace compassion and have an altruistic attitude. Such qualities in a doctor make medicine a vocation rather than a mere profession and was non-negotiable in the past, making medicine a noble profession. This aptitude needs to be tested, to ensure that the right candidate is chosen and not just the one with the highest marks in the science subjects.

It is not uncommon to see that the academically brilliant don't always become good doctors. This is a reality today, with a few, who were forced to take up medicine due to various compulsions, not finishing the course or getting past the finish line, never to practice medicine because they see themselves as misfits in the profession. Hence bringing in this component of testing for aptitude will result in a new acronym, NEAT (National Eligibility and Aptitude Test).

An alternative to NEET that is feasible and within the reach of MCI is a common exit exam prior to starting medical practice. This is the licensing exam similar to what is conducted in many of the countries where healthcare is robust. This is apart from the final MBBS exams and should be held after completion of internship. This exam need only be in English, and should test knowledge, skills and ethics of medicine, especially focusing on practical aspects achieved during internship. If this is a theory exam solely confined to MBBS subjects, students would skip internship and choose to sit and clear this theory exam. With regard to NEET for postgraduate education, which is being planned for 2017-18, there is no doubt that merit needs to be rewarded and corruption needs to be rooted out. With this single exam being planned, candidates after completing internship would choose to sit at coaching centres to pass the exam rather than work to acquire skills for life as a doctor. They feel no need to work and spend two to three years just studying without working, to make the grade in the postgraduate entrance examination. At present, the nature of the exam is such that only theory knowledge is tested and often the only way to eliminate is to ask questions which are of no practical significance. If the exam tested on clinical aspects of patient care, the candidate will feel the need to work and acquire skills by working with senior doctors who have a lot to offer. Working in the specialty of interest goes a long way towards developing life skills as a specialist.

The other tangible benefit to work as a junior doctor across specialties for a year or two prior to specialisation, is what a candidate can decide whether the specialty suits his or her skill sets. Most doctors after internship cannot decide for sure the specialisation to pursue, and only when the rubber hits the road are wise decisions made. This has its repercussions of a seat being wasted and the department losing out a hand at work.

Presently, there are candidates who do a diploma course prior to joining the degree programme. These candidates would be benefitted with a special paper in the specialty they are already trained in to make the higher grade. This currently does not exist at an all-India level. Candidates who have completed the diploma have to reapply to the all-India exam which tests them on all MBBS subjects. This would reflect in the future when there would be no takers for diploma courses.

This brings me to the point of the duration of postgraduate training. Right now, this is three years for a degree and two years for a diploma. This is woefully short and is looked critically at the time of application to fellowships overseas. Most postgraduate training programmes in the West are for a 4-6 year period. Those doctors who do a two-year diploma programme followed by a post diploma, two-year degree programme are better qualified and equipped as consultants in the specialty. If the candidate has spent one to two years as a senior house officer in the specialty prior to the diploma course, it only adds to their skill sets and holds them in good stead in the long run. Postgraduate training needs to be looked at very carefully in the country and a NEET testing on obscure theory knowledge is not the answer. We should move from a theory-based test to a skill-based, practically oriented entrance exam, which will work in favour of the candidate who works as a junior doctor in a busy hospital, especially if the candidate works in a rural hospital where the doctor depends upon clinical acumen to make a diagnosis. Mechanisms could be set in place to reward the doctor who has served in an area of need in the country. Right now, in a few states, rural service in the government sector for a short period is mandatory, however compliance is abysmal with candidates using this time only to prepare for the post graduate entrance examinations.